Large cervical myoma originating from the uterine corpus

Abstract

This case report aimed to present a case of large cervical myoma that obliterated the ureterovesical area and filled the entire cervix. A 33-year-old patient had a tumoral lesion of approximately 80x60 mm, compatible with myoma, that filled the cervical cavity. On vaginal examination, a barrel-shaped, immobile and large cervix was palpated. A preoperative bilateral double J catheter was applied to the patient. While the uterine cervix was barrel-shaped due to myoma and was palpable from Douglas, it was firmly fixed anteriorly to the bladder and corpus. During bladder dissection, approximately 4 cm defect was formed in the isthmus, and the uterine cavity was entered. A myoma with a diameter of approximately 9 cm, which filled the entire cervix from the uterine isthmus and had a stem attached to the fundus, was observed in the cavity, and the myoma was pulled out from the defect with a tenaculum and removed. Since the anterior cervix could not be reached and bladder dissection could not be achieved, a subtotal hysterectomy was performed. Although they are mainly treated surgically, there is no standard treatment for cervical myomas. Due to its proximity to vital organs, care should be taken against the risk of organ injury.

Keywords

• leiomyoma
• cervix
• hysterectomy

References

1. 1. Tiltman AJ. Leiomyomas of the uterine cervix: a study of frequency. Int J Gynecol Pathol. 1998;17(3):231-4.
2. 2. Chang WC, Chen SY, Huang SC, Chang DY, Chou LY, Sheu BC. Strategy of cervical myomectomy under laparoscopy. Fertil Steril. 2010;94(7):2710-5.
3. 3. Laganà AS, Ciancimino L, Mancuso A, Chiofalo B, Rizzo P, Triolo O. 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet. 2014;290(6):1173-8.
4. 4. Chang W-C, Chen S-y, Huang S-C, Chang D-Y, Chou L-Y, Sheu B-C. Strategy of cervical myomectomy under laparoscopy. Fertility and sterility. 2010;94(7):2710-5.
5. 5. Giannella L, Mfuta K, Tuzio A, Cerami LB. Dyspareunia in a Teenager Reveals a Rare Occurrence: Retroperitoneal Cervical Leiomyoma of the Left Pararectal Space. J Pediatr Adolesc Gynecol. 2016;29(1):e9-e11.
6. 6. Liu WM, Wang PH, Chou CS, Tang WL, Wang IT, Tzeng CR. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas. Fertil Steril. 2007;87(2):356-61.
7. 7. Sims JA, Brzyski R, Hansen K, Coddington CC, 3rd. Use of a gonadotropin releasing hormone agonist before vaginal surgery for cervical leiomyomas. A report of two cases. J Reprod Med. 1994;39(8):660-2.
8. 8. Sinha R, Sundaram M, Lakhotia S, Hegde A. Cervical myomectomy with uterine artery ligation at its origin. J Minim Invasive Gynecol. 2009;16(5):604-8.

9. 9. Takeuchi H, Shimanuki H, Kobori H, Kitade M, Kikuchi I, Kinoshita K. Effect of vasopressin on blood flow and RI of the uterine artery during laparoscopic myomectomy. J Minim Invasive Gynecol. 2005;12(1):10-1.
10. 10. Kilpatrick CC, Adler MT, Chohan L. Vaginal myomectomy in pregnancy: a report of two cases. South Med J. 2010;103(10):1058-60.
11. 11. Monaghan J, Lopes A, Naik R. Total hysterectomy for cervical and broad ligament fibroids.[In:] Huxley R., Taylor S., Chandler K.(ed.) Bonney’s gynaecological surgery 10th ed. Blackwell Publishing; 2004.
12. 12. Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, et al. Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature. Medicina (Kaunas). 2021;57(2).
13. 13. Wong J, Tan GHC, Nadarajah R, Teo M. Novel management of a giant cervical myoma in a premenopausal patient. BMJ Case Rep. 2017;2017.